When I first contacted Dr. Sean Fox (@PedEMMorsels) regarding participating in the How I Work Smarter series he described his work style as “a bull in a china shop”, questioning if he was a worthy participant. This, in fact, makes him an ideal contributor as most of us can relate to the difficulties of achieving organizational zen. But Dr. Fox is also being humble. He is double boarded in Emergency Medicine and Pediatrics. In his young career, he has already received several teaching awards including the ACEP National Faculty Teaching Award. He’s also embraced teaching through FOAM via his great site pedemmorsels.com. Dr. Fox generously took some time out to share some great thoughts on how he tries to shoot the efficiency moon.


  • Name:  Sean M. Fox, MD, FACEP, FAAPFox2014_05 square
  • Location: Charlotte, NC
  • Current job: Associate Professor, Assistant Program Director, Department of Emergency Medicine, Carolinas Medical Center
  • Most Important Job: Devoted husband and protective father
  • One word that best describes how you work: Doggedly
  • Current mobile device: iPhone 6 Plus (go big or go home)
  • Current computer: MacBook Pro (2014) and iMac (2009)

So, I think that I need to preface my following comments.  I do not see myself as exemplifying efficiency.  Many of my predecessors, who have enlightened us with their expert suggestions on how to “work smarter,” are masters of the craft of efficiency. They are my heroes. If they are the superheroes of efficiency, then I see myself more as a mere mortal who endeavors daily to be productive. Inertia is both our enemy and our friend. It is easier to keep moving if you don’t let it stop. I have no great insight in how to prevent the mass from becoming stagnant. All I know is to push on it a little each day.

What’s your office workspace setup like?

Fox Kitchen Island

I prefer to not have an “office” in the hospital. I work a fair amount of clinical shifts as well as spend every Thursday in our EM conferences at Carolinas, so if I’m not doing those two things I would rather be home. I try to coordinate the majority of my other meetings so that they are on Thursdays, after conference time. The vast majority of my meetings are with people who already have offices, so if need be, we meet in their spaces or in some of our larger work spaces. During interview season, I borrow other people’s offices… the best office space is someone else’s.

The majority of my non-clinical work gets done in a variety of locations… but mostly at home. I love my MacBook Pro for this as it is integrated so nicely with all of my various “cloud” connected devices. Using a combination of Box, Dropbox, GoogleDrive, and iCloud (I try to max out the available free space), I am able to work on projects whenever and where ever I have the time to. Often this is while I am sitting next to my children after school. I find it is a good life-lesson for them to see me doing “homework” next to them as they do their homework. Education is a journey not a goal.

What’s your best time-saving tip in the office or home?

Have as few meetings as possible! I find that the greatest waste of time occurs traveling to, waiting for, and sitting in meetings. No one likes them, but they are occasionally necessary. So, first determine if this meeting is actually one that will be productive and is needed. Will the meeting help to move a project forward, then figure out how to make that meeting efficient. If the meeting is essentially a means to convey information, well then it isn’t needed and you should help find a way to make either repurpose it or eliminate it. With today’s technologies, we have numerous means to convey information more effectively than a meeting. With that said, we also have a variety of tools that can help make more productive use of time on collaborative projects. Tools like Slack, Basecamp, GoogleDrive, and Evernote (I use all of them– you have to be amphibious to be collaborative across ecosystems) allow for truly collaborative work and diminishes the number of overall meetings while improving efficiency and productivity.

What’s your best time-saving tip regarding email management?

Do not let it own you.  Several people have already spoken of setting time aside to do email. In theory I love that idea, but that has not really worked for me that well. Likely because I am not disciplined enough to adhere to it. It also may be because scheduled email time just seems to add more items on my already over scheduled calendar.

I prefer to deal with items that need to be dealt with as soon as I can. Naturally, this requires a triage system. For this, I recommend setting up your email reader to display the most number of lines of each message possible so that you can screen your email quickly without opening individual messages. I agree with others who have said that you shouldn’t touch an email more than once… but, if your quick screen finds an item that may require more time or thought, leave it unopened. If it can be quickly answered, do it. If it is trash, delete it expeditiously (my favorite hobby is deleting unopened email that fails my screening criteria). During those haphazard free moments that occur sporadically, I quickly triage my email with the aim of making my dedicated email time, that may (or may not) occur later, more manageable.

I also would recommend having several email addresses that can help to segregate your email inbox natively.

What’s your best time-saving tip in the ED?

Think out loud

We all collect data the instant we walk into a patient’s room. We start to stratify the patient on the sick – not sick scale.  We begin to juggle risk:benefit equations and sort through enormous databases of differential diagnoses. We determine a plan of action.  Many times we do all of this without uttering a word. Patient’s are concerned, if not outright fearful, and will remain that way until you speak. By thinking out loud you are able to touch upon many of the items that they are concerned about, often helping to avoid unnecessary testing. It also helps you to prime your medical management machine (AKA, your brain).  I have often reminded myself of important entities on the differential as I am thinking out loud with the patient.

It also shows the patient and the family that you are doing A LOT of stuff, even though you may not end up ordering any tests. We have all seen patients after they had a billion dollar work up the day before and they say that our colleagues “didn’t DO anything.” We know that “stuff” was done, but the work was not perceived. Get credit for all of the brain-work you do. Think out loud.

Teach as you go

Yes, this even applies to those of us who do not have medical students or residents. We all teach. We teach parents. We teach patients. We teach each other. With respect to your patients and being efficient, I find the best way is to think out loud as I do my exam. This is especially fun with kids as you quiz them on the location of their internal organs, which distracts them, and allows you to smash on their bellies, which demonstrates to the parents that a CT is not needed.

ED charting: Macros or no macros?

I have the distinct privilege of working with amazing Carolinas EM residents, so my charting is most often constituted by some quick keystrokes of autotext that I then augment with the specifics of the individual case. I never “rubber stamp” physical exams. When I see patients on my own (yup, I get to see my own patients and act “academic” with brilliant people), I use some Macros for Review of Systems and common medical decision making (ex, Chest Pain, Abdominal Pain, Minor trauma), but all are adjusted and augmented.

What’s the best advice you’ve ever received about work, life, or being efficient?

  • Measure twice. Cut once.
  • Use your head to save your back (or butt).

Both essentially focus on the same point.  If you put in the work up front, you will save time in the end. This gets back to the Thinking Out Loud and Teach As You Go. It may seem like you are spending more time in the room at first, but this attention in the beginning pays dividends later and saves you from having to make multiple trips back into the room.

Is there anything else you’d like to add that might be interesting to readers?

  • Be awesome! In every role you play, at home or at work or at the little league ball field, strive to be awesome.
  • Hell is boredom. We all have our own depiction of hell, but I think the greatest torture is being bored. My kids say that to me all the time… “Dad, we are bored.” So, stay busy. You might not change the world, but you may save your soul. (Ok, that was a little over the top).

Who would you love for us to track down to answer these same questions?

  1. Dr. Marianne Gausche-Hill
  2. Dr. Michael Gibbs
Benjamin Azan, MD

Benjamin Azan, MD

Emergency Physician
Lincoln Medical Center
Founder/Editor of foambase.org
Benjamin Azan, MD


ED attending in NYC, #FOAMed enthusiast, #MedEd, founder of https://t.co/29SO7xxO8X
Benjamin Azan, MD

Latest posts by Benjamin Azan, MD (see all)